Liz B. is a 73-year-old white woman who is seeing her doctor for a regular physi

Question

Liz B. is a 73-year-old white woman who is seeing her doctor for a regular physical. She is married and retired, but volunteers for several organizations and watches her grandchildren two mornings a week. She and her husband play golf about once a week during the spring, summer, and fall. She weighs 130 pounds and always thought she was 5’6”. However, when she was measured at this physical, she was 5’4”. Because of her age and height loss, she has a dual-energy x-ray absorptiometry (DEXA) measurement that shows that she has low bone mineral density (BMD) values of her proximal femur and lumbar vertebrae (both values are classified as osteoporotic according to World Health Organization definitions). A chest x-ray also revealed two vertebral fractures. However, she has no pain in her back or neck. The RDN and Liz discuss her diet, concluding that her diet is low in calcium and vitamin D, but high in sodium. Along with suggestions to decrease her sodium intake and increase her fruit and vegetable intake, she is advised to start taking supplements of calcium (1000 mg/day) and vitamin D (800 units/day). They discuss avoiding high-impact exercise affecting the spine because of the low bone mass and existing vertebral fractures, but increasing flexibility, balance, and posture exercises. Because of the DXA results, she also begins on a bisphosphonate drug in addition to the calcium and vitamin D supplements. She receives baseline tests of bone turnover, to be rechecked in 6 months and an appointment for another DXA in 1 year. After 1 year on the medication, supplements, diet and exercise changes, Liz has another DXA. Her BMD has improved to the osteopenia level, and she is taken off the bisphosphonate medication.

1- If Liz wants to increase her calcium through fortified foods rather than a supplement, how would you counsel her? Give examples (2)

2- If Liz’s sodium intake is high, how does that influence her BMD? What would you advise her to eat less frequently? (3)

3- How does the medication, bisphosphonate work to improve/maintain bone mass for Liz? (2)

4- The WHO’s risk algorithm (FRAX) needs what data to calculate score? (3)

5- What risk factors does Liz have for developing osteoporosis? Be specific. (3)

6- What medications will increase risk for osteoporosis? Use textbook reference pages (3)

7- What two hormones regulate calcium concentration? (2)

8- When did Liz reach her peak bone mass? (1)

9- In talking with Liz, you outline foods that interfere with calcium absorption, what are they? (2)

10- What are the National Osteoporosis Foundation’s universal guidelines for all adults for the prevention of osteoporosis? (4)

Explanation / Answer

1). 1- If Liz wants to increase her calcium through fortified foods rather than a supplement, how would you counsel her? Give examples (2)

Postmenopausal women are at high risk of osteoporosis due to the reduced estrogen levels. Mrs. Liz B. is low in calcium and requires 1200 mg of calcium (as she is 73 years old). One reason that Liz has to take calcium supplements is, the calcium absorption decreases with increasing age.

However, she can take calcium-rich foods along with the supplements. For example, the green leafy vegetables and milk products.

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